Benner (1984) describes the “growing edges of knowledge” demonstrating that we can “preserve and extend knowledge”. Benner also introduces the concepts of ‘know how’ and ‘know that’. She describes how you can know how without knowing that. Knowing how is is described as the completion of a task; for example knowing how to give an injection. The ‘knowing that’ element relates to the action of the drug, side effects, interactions etc. Both elements of vital for safe vascular access and infusion therapy.
One concept that may help to take forward how we teach vascular access and infusion therapy are elements known as ‘background’ and ‘foreground’ knowledge. Straus (2011:17) describes that “clinical practice demands the use of large amounts of both background and foreground knowledge”. Background knowledge acts as an ‘archive’. The ‘imaginative’ and ‘enquiring‘ foreground knowledge moves the clinician into the realms of knowledgeable doer (UKCC 1986).
When teaching, background knowledge may be illustrated by the type of questions that are asked by the learners. Those with little experience will depend upon a greater number of background questions. The answers to these questions help to frame the issue within an expected knowledge base. Examples would include normal blood pressure range or glucose levels in the blood. Once a person begins to fill the background knowledge component they move into foreground questioning. Without this opportunity to enquire, further learning would be stifled.
These concepts of adequately prepared learners is vital if we are to continue to build upon existing knowledge. As Fisher, Ross and Grant (2010:23) suggest “lack of background knowledge can have an impact on their ability to ask questions and wonder—both key components of inquiry”. Once background knowledge is built and activated it can be combined with foreground knowledge. It is this ability to process knowledge in this efficient manner that helps knowledge to be integrated into practice. When we teach vascular access and infusion therapy it is important that we identify both ‘background’ and ‘foreground’ learning elements.
I regularly see skill sessions on topics such as cannulation full to the brim with ‘background’ components. These main skill sections include topics such as cleaning the skin, skin tension, angle of insertion, first and second flashback etc. This ‘background’ experience allows the practitioner to learn cannulation. It is at this point that we may even describe the learner as competent! However, if we visit the concept of ‘foreground’ knowledge we begin to acknowledge the intricate components of skill completion that transports a practitioner beyond the level of novice. We can begin to understand the importance of foreground knowledge. Placing a vascular access device within a vein is only one component of successful vascular access. If we are to improve the vascular access experience for our patients we must extend the foreground knowledge of our learners. Foreground knowledge offers a rationale for our actions. For example, foreground knowledge on disinfecting the skin moves the learner beyond skin cleansing; taking them to knowing how and why we clean the skin and what is likely to happen if we fail to complete the task to the expected standard.
Background knowledge is essential; foreground knowledge brings understanding and may increases procedural compliance.
BENNER, Patricia E. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.
FISHER, D., ROSS, D. and GRANT, M., 2010. Building Background Knowledge. The Science Teacher, 77(1), 23-26.
STRAUS, Sharon E. (2011). Evidence-based medicine: How to practice and teach it. Edinburgh, Elsevier Churchill Livingstone.
UKCC – UNITED KINGDOM CENTRAL COUNCIL FOR NURSING, MIDWIFERY AND HEALTH VISITING (1986). Project 2000: A new preparation for practice UKCC. London.